People’s lives often depend on the quick reaction and competent care of emergency medical technicians (EMTs) and paramedics—EMTs with additional advanced training to perform more difficult prehospital medical procedures. Incidents as varied as automobile accidents, heart attacks, drownings, childbirth, and gunshot wounds all require immediate medical attention. EMTs and paramedics provide this vital attention as they care for and transport the sick or injured to a medical facility.

In an emergency, EMTs and paramedics typically are dispatched to the scene by a 911 operator, and often work with police and fire department personnel. (Police and detectives and firefighting occupations are discussed elsewhere in the Handbook.) Once they arrive, they determine the nature and extent of the patient’s condition while trying to ascertain whether the patient has preexisting medical problems. Following strict rules and guidelines, they give appropriate emergency care and, when necessary, transport the patient. Some paramedics are trained to treat patients with minor injuries on the scene of an accident or at their home without transporting them to a medical facility. Emergency treatment for more complicated problems is carried out under the direction of medical doctors by radio preceding or during transport.

EMTs and paramedics may use special equipment, such as backboards, to immobilize patients before placing them on stretchers and securing them in the ambulance for transport to a medical facility. Usually, one EMT or paramedic drives while the other monitors the patient’s vital signs and gives additional care as needed. Some EMTs work as part of the flight crew of helicopters that transport critically ill or injured patients to hospital trauma centers.

At the medical facility, EMTs and paramedics help transfer patients to the emergency department, report their observations and actions to emergency room staff, and may provide additional emergency treatment. After each run, EMTs and paramedics replace used supplies and check equipment. If a transported patient had a contagious disease, EMTs and paramedics decontaminate the interior of the ambulance and report cases to the proper authorities.

Beyond these general duties, the specific responsibilities of EMTs and paramedics depend on their level of qualification and training. To determine this, the National Registry of Emergency Medical Technicians (NREMT) registers emergency medical service (EMS) providers at four levels: First Responder, EMT-Basic, EMT-Intermediate, and EMT-Paramedic. Some States, however, do their own certification and use numeric ratings from 1 to 4 to distinguish levels of proficiency.

The lowest-level workers—First Responders—are trained to provide basic emergency medical care because they tend to be the first persons to arrive at the scene of an incident. Many firefighters, police officers, and other emergency workers have this level of training. The EMT-Basic, also known as EMT-1, represents the first component of the emergency medical technician system. An EMT-1 is trained to care for patients at the scene of an accident and while transporting patients by ambulance to the hospital under medical direction. The EMT-1 has the emergency skills to assess a patient’s condition and manage respiratory, cardiac, and trauma emergencies.

The EMT-Intermediate (EMT-2 and EMT-3) has more advanced training that allows the administration of intravenous fluids, the use of manual defibrillators to give lifesaving shocks to a stopped heart, and the application of advanced airway techniques and equipment to assist patients experiencing respiratory emergencies. EMT-Paramedics (EMT-4) provide the most extensive prehospital care. In addition to carrying out the procedures already described, paramedics may administer drugs orally and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment.

EMTs and paramedics work both indoors and outdoors, in all types of weather. They are required to do considerable kneeling, bending, and heavy lifting. These workers risk noise-induced hearing loss from sirens and back injuries from lifting patients. In addition, EMTs and paramedics may be exposed to diseases such as hepatitis-B and AIDS, as well as violence from drug overdose victims or mentally unstable patients. The work is not only physically strenuous, but can be stressful, sometimes involving life-or-death situations and suffering patients. Nonetheless, many people find the work exciting and challenging and enjoy the opportunity to help others.

EMTs and paramedics employed by fire departments work about 50 hours a week. Those employed by hospitals frequently work between 45 and 60 hours a week, and those in private ambulance services, between 45 and 50 hours. Some of these workers, especially those in police and fire departments, are on call for extended periods. Because emergency services function 24 hours a day, EMTs and paramedics have irregular working hours.

EMTs and paramedics held about 192,000 jobs in 2004. Most career EMTs and paramedics work in metropolitan areas. Volunteer EMTs and paramedics are more common in small cities, towns, and rural areas. These individuals volunteer for fire departments, emergency medical services (EMS), or hospitals, and may respond to only a few calls for service per month or may answer the majority of calls, especially in smaller communities. EMTs and paramedics work closely with firefighters, who often are certified as EMTs as well and act as first responders. A large number of EMTs or paramedics belong to a union.

Full-time and part-time paid EMTs and paramedics were employed in a number of industries. About 4 out of 10 worked as employees of private ambulance services. About 3 out of 10 worked in local government for fire departments, public ambulance services, and EMS. Another 2 out of 10 were found in hospitals, working full time within the medical facility or responding to calls in ambulances or helicopters to transport critically ill or injured patients. The remainder worked in various industries providing emergency services.

Formal training and certification is needed to become an EMT or paramedic. A high school diploma is typically required to enter a formal training program. Some programs offer an associate degree along with the formal EMT training. All 50 States have a certification procedure. In most States and the District of Columbia, registration with the NREMT is required at some or all levels of certification. Other States administer their own certification examination or provide the option of taking the NREMT examination. To maintain certification, EMTs and paramedics must reregister, usually every 2 years. In order to reregister, an individual must be working as an EMT or paramedic and meet a continuing education requirement.

Training is offered at progressive levels: EMT-Basic, also known as EMT-1; EMT-Intermediate, or EMT-2 and EMT-3; and EMT-Paramedic, or EMT-4. EMT-Basic coursework typically emphasizes emergency skills, such as managing respiratory, trauma, and cardiac emergencies, and patient assessment. Formal courses are often combined with time in an emergency room or ambulance. The program also provides instruction and practice in dealing with bleeding, fractures, airway obstruction, cardiac arrest, and emergency childbirth. Students learn how to use and maintain common emergency equipment, such as backboards, suction devices, splints, oxygen delivery systems, and stretchers. Graduates of approved EMT basic training programs who pass a written and practical examination administered by the State certifying agency or the NREMT earn the title “Registered EMT-Basic.” The course also is a prerequisite for EMT-Intermediate and EMT-Paramedic training.

EMT-Intermediate training requirements vary from State to State. Applicants can opt to receive training in EMT-Shock Trauma, wherein the caregiver learns to start intravenous fluids and give certain medications, or in EMT-Cardiac, which includes learning heart rhythms and administering advanced medications. Training commonly includes 35 to 55 hours of additional instruction beyond EMT-Basic coursework, and covers patient assessment as well as the use of advanced airway devices and intravenous fluids. Prerequisites for taking the EMT-Intermediate examination include registration as an EMT-Basic, required classroom work, and a specified amount of clinical experience.

The most advanced level of training for this occupation is EMT-Paramedic. At this level, the caregiver receives additional training in body function and learns more advanced skills. The Technology program usually lasts up to 2 years and results in an associate degree in applied science. Such education prepares the graduate to take the NREMT examination and become certified as an EMT-Paramedic. Extensive related coursework and clinical and field experience is required. Because of the longer training requirement, almost all EMT-Paramedics are in paid positions, rather than being volunteers. Refresher courses and continuing education are available for EMTs and paramedics at all levels.

EMTs and paramedics should be emotionally stable, have good dexterity, agility, and physical coordination, and be able to lift and carry heavy loads. They also need good eyesight (corrective lenses may be used) with accurate color vision.

Advancement beyond the EMT-Paramedic level usually means leaving fieldwork. An EMT-Paramedic can become a supervisor, operations manager, administrative director, or executive director of emergency services. Some EMTs and paramedics become instructors, dispatchers, or physician assistants, while others move into sales or marketing of emergency medical equipment. A number of people become EMTs and paramedics to assess their interest in health care, and then decide to return to school and become registered nurses, physicians, or other health workers.

Employment of emergency medical technicians and paramedics is expected to grow much faster than the average for all occupations through 2014, as full-time paid EMTs and paramedics replace unpaid volunteers. As population and urbanization increase, and as a large segment of the population—aging baby boomers—becomes more likely to have medical emergencies, demand will increase for EMTs and paramedics. There will still be demand for part-time, volunteer EMTs and paramedics in rural areas and smaller metropolitan areas. In addition to jobs arising from growth, openings will occur because of replacement needs; turnover is relatively high in this occupation because of the limited potential for advancement and the modest pay and benefits in private-sector jobs.

Job opportunities should be best in private ambulance services. Competition will be greater for jobs in local government, including fire, police, and independent third-service rescue squad departments, in which salaries and benefits tend to be slightly better. EMTs and paramedics who have advanced certifications, such as EMT-Intermediate and EMT-Paramedic, should enjoy the most favorable job prospects as clients and patients demand higher levels of care before arriving at the hospital.

Earnings of EMTs and paramedics depend on the employment setting and geographic location as well as the individual’s training and experience. Median annual earnings of EMTs and paramedics were $25,310 in May 2004. The middle 50 percent earned between $19,970 and $33,210. The lowest 10 percent earned less than $16,090, and the highest 10 percent earned more than $43,240. Median annual earnings in the industries employing the largest numbers of EMTs and paramedics in May 2004 were:

Local government
General medical and surgical hospitals
Other ambulatory health care services

$27,710
26,590
23,130

Those in emergency medical services who are part of fire or police departments receive the same benefits as firefighters or police officers. For example, many are covered by pension plans that provide retirement at half pay after 20 or 25 years of service or if the worker is disabled in the line of duty.

Other workers in occupations that require quick and level-headed reactions to life-or-death situations are air traffic controllers, firefighting occupations, physician assistants, police and detectives, and registered nurses.